Pain Medicine has evolved tremendously in recent years. Dr. Williams offers
effective strategies to treat pain that do not involve medications and
the related side-effects and complications that may range from occasional
nuisance to catastrophic. Dr. Williams’ Center for Sports Neurology
and Pain Medicine is comprised of Neurological Pain Medicine specialists
and employ a Neurologically-oriented approach to acute, sub-acute, chronic,
nociceptive, and neuropathic pain. While Dr. Williams and his team are
experts in the rational and judicious prescription of medications for
pain, he focuses on opportunities to apply the Neuromodulation techniques
at his discretion.
Neuromodulation is the alteration of nerve activity through targeted delivery
of a stimulus, such as electrical stimulation or chemical agents, to specific
neurological sites in the body. In other words, we can turn up or turn
down and off the specific peripheral nerves that are sending pain signals
to reduce and/or eliminate pain. This can help enhance and improve physical
function, professional and overall quality of life, sports performance,
and self-esteem through neuromodulation.
Dr. Williams has successfully used Neuromodulation techniques on elite
and professional athletes as well as collegiate, high school, and youth
athletes to eliminate pain – allowing them to pursue and excel in
high level, competitive, and aggressive physical activities without pain.
In addition, Dr. Williams has successfully used these techniques in consultation
with his expert Cedars-Sinai Kerlan-Jobe Institute surgical partners before
and after surgery (and in some cases
instead of surgery).
Not all of our patients are athletes. In fact, many of Dr. Williams’
patients are hardworking professionals who need to continue on the job
without pain, elderly patients who want to maintain their physical function,
and students who need to focus on studies and seek us out because they
are tired of taking medications for pain relief. They are interested in
safe and effective therapy options that eliminate medication-related side
effects and reduce the unwanted exposure to opioid or narcotic medications.
Listed below are examples of commonly used, safe, minimally invasive,
and effective ways to alter peripheral nerve activity and pain through
Myoscience iovera°® Technology
Cryoablation has been used extensively for pain control over the years,
but the newest technologies are far more precise relative to the temperatures
applied and have a form factor that allows easy, safe, effective and minimally
invasive in-office treatment.
Myoscience’s iovera°® technology is a cryoablation tool typically used at the Center under ultrasound guidance
to “freeze” selected superficial sensory nerves for the treatment
of knee, foot, rib, and upper extremity pain as well as headache. The
procedure usually lasts approximately 15-30 minutes. Patients may feel
a cool, warm, or tingling sensation, but not pain. The Iovera cryoablation
does not “kill” nerves. The target nerve will eventually regenerate
(potentially after several months or longer) but can be retreated if necessary.
Bioness’ StimRouter peripheral nerve implants offer a safe, effective and minimally invasive
way to target a specific peripheral nerve and deliver precise, focused
electrical stimulation to block chronic pain. These procedures are performed
with light sedation in our Kerlan-Jobe Surgery Center. The procedure involves
placing a small electrical lead under the skin near the target nerve,
using ultrasound or fluoroscopic guidance for precision. The procedure
lasts approximately 30 minutes. During follow up, Dr. Williams, his team,
and StimRouter experts assist in programming a personalized external pulse
transmitter (applied to the skin overlying the implanted electrode) and
remote. StimRouter empowers the implanted patient to have complete, customized
wireless control in delivering the stimulation to the lead, and most importantly,
Radiofrequency Denervation (Rhizotomy)
Radiofrequency forms of Neuromodulation offer safe, effective and minimally
invasive ways to target peripheral nerves and deliver precise, focused
stimulation to block chronic, peripheral nerve pain. These procedures
are performed in the Kerlan-Jobe Surgery Center. The procedure involves
using a fluoroscope x-ray or ultrasound to visualize target structures.
An electrode is temporarily placed adjacent to the nerve structure to
be treated so that a radiofrequency signal can deliver carefully controlled
stimulation (either continuous or in “pulses”) to a target
nerve. This signal prevents nerves from sending pain signals and results
in desensitization, reduction and/or elimination of pain. The procedure
lasts approximately 15-30 minutes. There is light sedation and anesthesia
involved to help with relaxation and comfort.